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February 2015 | Read this issue and more at www.healthandwellnessmagazine.net |
Delirium:
What It Means for Patients
and Caregivers
By Dr. Tom Miller, Staff Writer
Delirium is confusion in thinking,
sometimes experienced by human
beings in later life, after trauma,
or post-surgery. The Mayo Clinic
defines delirium as a serious disturbance in a person’s mental abilities
that results in a decreased awareness
of one’s environment and confused
thinking. The onset of delirium is
usually sudden, often within hours
or a few days. Delirium can often be
traced to one or more contributing
factors, such as a severe or chronic
medical illness, medication, infection,
surgery, or drug or alcohol abuse. The
symptoms of delirium and dementia can be similar, and input from a
family member or caregiver may be
important for a doctor to make an
accurate diagnosis.
Caregivers begin to recognize
delirium when a loved one shows
fluctuating periods of attention and
inattention. Some of the core features present with limited clarity in
awareness of the environment and
limited ability to focus on what is
being discussed. Problem-solving
skills are impaired and one’s thinking appears to be slow and muddled.
Delirium itself is not a disease, but
rather a clinical syndrome (a set of
symptoms), which results from an
underlying disease, from medications
administered during treatment of
that disease in a critical phase, from
a new problem with mentation, or
from varying combinations of two or
more of these factors. Delirium as a
syndrome occurs more frequently in
people in their later years. However,
when it occurs in the course of a critical illness, delirium has been found
to occur in young and old patients at
relatively even rates.
Delirium can show itself post-
operatively in some older patients.
The American Geriatrics Society
recently released new guidelines
for treating and preventing postoperative delirium in older adults. The
evidence-based recommendations
were published online in the Journal
of the American College of Surgeons
and on the American Geriatrics
Society’s website. The multi-specialty
and interdisciplinary panel recommended that teams administer
non-pharmacologic interventions
to at-risk older adults to address
delirium signs and symptoms. The
researchers defined delirium as an
episode of sudden confusion and a
serious medical condition that can
occur following surgery and lead to
longer hospital stays, delayed rehabilitation, and other complications.
Examples of their recommended nonpharmacologic approaches include
mobility and walking, avoiding physical restraints, orienting older adults to
their surroundings, sleep hygiene, and
assuring adequate oxygen, fluids, and
nutrition. The panel also suggested
performing medical evaluations to
identify and manage contributors to
delirium, and providing healthcare
professionals with ongoing education
regarding delirium. Caregivers may
also use some of these strategies in
the care of their loved ones, and this
may reduce the use of certain medications with high risk patients.
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Based on the results of this study,
caregivers of someone with signs
of delirium can help manage symptoms. Caregivers can promote good
sleep habits, encourage exercise and
activity during the day, and provide
a decaffeinated beverage before
bedtime. In addition, caregivers
can help with orientation to time,
place and person. It may be helpful
to have a clock and calendar readily
available, and refer to them regularly
throughout the day. Also important
is communication about any change
in activity, such as time for lunch
or time for bed. Identify yourself or
other people frequently and keep
noise levels and other distractions
to a minimum. Make sure loved
ones use their eyeglasses and hearing
aids, and be sure the person keeps
a regular daily written schedule. As
a caring caregiver for a person with
delirium, consider joining a support
group. Examples of organizations
that may provide helpful information
to caregivers include the National
Family Caregivers Association and
the National Institute on Aging.
Sources and Resources
Mayo Clinic (2015) Learning about
Delirium. Available at: http://www.
mayoclinic.org/diseases-conditions/
DELIRIUM Continued on Page 47
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